Home-based physical therapy may reduce functional decline among moderately frail elderly adults
- Paw, Marijke Chin A PhD
BACKGROUND
Functional decline is associated with significant morbidity in physically frail elderly adults. It is unclear whether functional decline can be prevented.
OBJECTIVE
To assess whether a home-based physical therapy programme targeting underlying physical impairments can reduce functional decline in frail elderly adults.
SETTING
Recruitment from primary care practices in Southern Connecticut, USA; enrolment October 1998 to July 2000.
METHOD
Randomised controlled trial.
PARTICIPANTS
One hundred and eighty-eight people older than 75 years who were physically frail and living at home. People were considered physically frail if they took more than 10 seconds to perform a rapid walk test or if they could not stand up from a hard backed chair with their arms folded. People who fulfilled one of these criteria were considered 'moderately frail.' People who fulfilled both criteria were considered 'severely frail.' Exclusion criteria were inability to walk; undergoing physical therapy; participating in exercise programme; not fluent in English; diagnosis of dementia; score of less than 20 on Mini-Mental State Examination of cognitive status; life expectancy less than 12 months, or stroke, hip fracture, myocardial infarction or hip or knee replacement surgery within 6 months.
INTERVENTION
Home-based physical therapy programme or educational programme (controls). The physical therapy programme focused on improving physical impairments such as balance, muscle strength and mobility. The educational controls received advice about nutrition, sleep, hygiene and managing medications. The educational controls received monthly home visits for 6 months. The physical therapy group received an average of 14.9 home visits over 6 months. Both groups received monthly telephone calls for an additional 6 months.
OUTCOMES
Change in scores on a disability scale (from baseline to 3, 7 and 12 months).
MAIN RESULTS
Sixty-five percent of the intervention group completed the physical therapy programme and 83% of controls completed the education programme. The physical therapy group had less functional decline over time compared to controls (Table 1). Benefits were observed in people with moderate frailty, but not in those with severe frailty. There was no significant difference in admissions to nursing homes (14% of physical therapy group versus 19% of controls, p=0.4).
AUTHORS' CONCLUSIONS
A home-based physical therapy programme targeting underlying physical impairments reduced the progression of functional decline in moderately frail elderly adults.