Enhanced Medical Rehabilitation Increases Therapy Intensity and Engagement and Improves Functional Outcomes in Postacute Rehabilitation of Older Adults: A Randomized-Controlled Trial |
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| Authors: | Eric J Lenze Helen H Host Mary W Hildebrand Nancy Morrow-Howell Brian Carpenter Kenneth E Freedland Carolyn A Baum David Dixon Peter Doré Leah Wendleton Ellen F Binder |
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| Institution: | 1. Department of Psychiatry, Washington University, St Louis, MO;2. Program in Physical Therapy, Washington University, St Louis, MO;3. Department of Internal Medicine, Washington University, St Louis, MO;4. Department of Occupational Therapy, East Carolina University, Greenville, NC;5. School of Social Work, Washington University, St Louis, MO;6. Department of Psychology, Washington University, St Louis, MO;7. Program in Occupational Therapy, Washington University, St Louis, MO;1. The University of Texas Health Science Center, School of Public Health, United States;2. The UT Southwestern Harold C. Simmons Comprehensive Cancer Center, United States;3. The University of Houston, College of Education, United States;4. The University of Texas, School of Social Work, United States;5. The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, United States;6. The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, United States;7. The Catholic University of America, Department of Psychology, United States;1. Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA;2. Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA;3. Veterans Affairs Pittsburgh Healthcare System (VAPHS), Pittsburgh, PA;4. Geriatric Pharmaceutical Outcomes and Gero-Informatics Research and Training Program, University of Pittsburgh, Pittsburgh, PA;5. Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA |
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| Abstract: | ObjectivesFor millions of disabled older adults each year, postacute care in skilled nursing facilities is a brief window of opportunity to regain enough function to return home and live independently. Too often this goal is not achieved, possibly because of therapy that is inadequately intense or engaging. This study tested Enhanced Medical Rehabilitation, an intervention designed to increase patient engagement in, and intensity of, daily physical and occupational therapy sessions in postacute-care rehabilitation.DesignRandomized controlled trial of Enhanced Medical Rehabilitation versus standard-of-care rehabilitation.SettingPostacute care unit of a skilled nursing facility in St Louis, MO.ParticipantsTwenty-six older adults admitted from a hospital for postacute rehabilitation.InterventionBased on models of motivation and behavior change, Enhanced Medical Rehabilitation is a set of behavioral skills for physical and occupational therapists that increase patient engagement and intensity, with the goal of improving functional outcome, through (1) a patient-directed, interactive approach, (2) increased rehabilitation intensity, and (3) frequent feedback to patients on their effort and progress.MeasurementsTherapy intensity: assessment of patient active time in therapy sessions. Therapy engagement: Rehabilitation Participation Scale. Functional and performance outcomes: Barthel Index, gait speed, and 6-minute walk.ResultsParticipants randomized to Enhanced Medical Rehabilitation had higher intensity therapy and were more engaged in their rehabilitation sessions; they had more improvement in gait speed (improving from 0.08 to 0.38 m/s versus 0.08 to 0.22 in standard of care, P = .003) and 6-minute walk (from 73 to 266 feet versus 40 to 94 feet in standard of care, P = .026), with a trend for better improvement of Barthel Index (+43 points versus 26 points in standard of care, P = .087), compared with participants randomized to standard-of-care rehabilitation.ConclusionHigher intensity and patient engagement in the postacute rehabilitation setting is achievable, with resultant better functional outcomes for older adults. Findings should be confirmed in a larger randomized controlled trial. |
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