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The Rehabilitation Enhancing Aging Through Connected Health Prehabilitation Trial
Institution:1. New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA;2. Harvard Medical School, Boston, MA;3. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA;4. College of Health and Rehabilitation Sciences: Sargent, Boston University, Boston, MA;5. Heller School for Social Policy and Management, Brandeis University, Waltham, MA;6. Department of Medicine, Brigham and Women’s Hospital, Boston, MA;7. Bloomsburg University of Pennsylvania, Bloomsburg, PA;1. Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience, Maastricht, The Netherlands;2. Limburg Brain Injury Centre, Maastricht, The Netherlands;3. Occupational Therapy, School of Allied Health, College of Science, Health, and Engineering, La Trobe University, Melbourne, Australia;4. Neurorehabilitation and Recovery, Stroke Division Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia;5. St. Vincent’s Hospital, Melbourne, Fitzroy, Australia;6. Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO;7. Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands;8. University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands;9. Maastricht University, Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht, the Netherlands;1. Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts;2. University of Washington, Seattle, Washington;3. Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;4. Brigham and Women’s Hospital, Boston, Massachusetts;5. University of Texas Medical Branch, Shriners Hospitals for Children-Galveston, Galveston, Texas;6. Harborview Medical Center, University of Washington, Seattle, Washington;7. University of Texas Southwestern Medical Center, Dallas, Texas;8. Shriners Hospitals for Children-Boston, Boston, Massachusetts;1. Department of Physiotherapy, Singapore General Hospital, Singapore;2. Department of Orthopaedic Surgery, Singapore General Hospital, Singapore;3. School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia;4. Department of Rheumatology and Immunology, Singapore General Hospital, Singapore;5. Research Health Institute, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia;6. Department of Physiotherapy, Sengkang General Hospital, Singapore;7. SingHealth Group Allied Health, Singapore;1. Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location VU University Medical Center, Amsterdam, Netherlands;2. Department of Neurorehabilitation, Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands;3. Revant Rehabilitation Centers, Breda, Netherlands;1. Department of Rehabilitation Medicine, Division of Occupational Therapy, University of Washington, Seattle, Washington;2. Department of Occupational Therapy, Ithaca College, Ithaca, New York;3. Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois;1. Department of Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland;2. University of Brescia, Brescia, Italy;3. IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
Abstract:ObjectiveTo evaluate the proof of concept of an innovative model of physical therapy Rehabilitation Enhancing Aging through Connected Health (REACH) and evaluated its feasibility and effect on physical function and health care utilization.DesignQuasi-experimental 12-month clinical trial.SettingTwo outpatient rehabilitation centers.ParticipantsCommunity-dwelling older primary care patients with a treatment arm undergoing the intervention (n=75; mean age=77±5.9y; 54% women) and propensity matched controls derived from a longitudinal cohort study (n=430; mean age=71±7.0y; 68% women) using identical recruitment criteria (N=505).InterventionCombined outpatient and home PT augmented with a commercially available app and computer tablet.MeasurementsPrimary outcomes included a feasibility questionnaire, exercise adherence, self-reported function, and the Short Physical Performance Battery (SPPB). Secondary outcomes included the rates of emergency department (ED) visits and hospitalizations.ResultsAmong REACH participants, we observed a 9% dropout rate. After accounting for dropouts, with propensity matching, n=68 treatments and n=100 controls were analyzed. Over the 12-month study duration, 85% of participants adhered to the exercise program an average of 2 times a week and evaluated the treatment experience favorably. In comparison to controls, after 1 year of treatment and within multivariable regression models, REACH participants did not manifest a significant difference in patient reported function (group x time effect 1.67 units, P=.10) but did manifest significant differences in SPPB (group x time effect 0.69 units, P=.03) and gait speed (group x time effect .08m/s, P=.02). In comparison to controls, after 1 year, the rate of ED visits (group x time treatment rate=0.27, P<.004) were significantly reduced, but a significant reduction in hospitalizations was not observed.ConclusionThe REACH intervention is feasible and has proof of concept in preventing functional decline and favorably affecting health care utilization. Evaluation on a larger scale is warranted.
Keywords:Aged  Healthcare  Mobility limitation  Rehabilitation  Telehealth  BMI"}  {"#name":"keyword"  "$":{"id":"kwrd0040"}  "$$":[{"#name":"text"  "_":"body mass index  Boston RISE"}  {"#name":"keyword"  "$":{"id":"kwrd0050"}  "$$":[{"#name":"text"  "_":"Boston Rehabilitative Impairment Study of the Elderly  ED"}  {"#name":"keyword"  "$":{"id":"kwrd0060"}  "$$":[{"#name":"text"  "_":"emergency department  LLWS"}  {"#name":"keyword"  "$":{"id":"kwrd0070"}  "$$":[{"#name":"text"  "_":"Live Long Walk Strong  LLFDI"}  {"#name":"keyword"  "$":{"id":"kwrd0080"}  "$$":[{"#name":"text"  "_":"Late Life Function and Disability Instrument  PT"}  {"#name":"keyword"  "$":{"id":"kwrd0090"}  "$$":[{"#name":"text"  "_":"physical therapist  REACH"}  {"#name":"keyword"  "$":{"id":"kwrd0100"}  "$$":[{"#name":"text"  "_":"Rehabilitation Enhancing Aging through Connected Health  SPPB"}  {"#name":"keyword"  "$":{"id":"kwrd0110"}  "$$":[{"#name":"text"  "_":"Short Physical Performance Battery
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