TY - JOUR
T1 - Enhanced Medical Rehabilitation Increases Therapy Intensity and Engagement and Improves Functional Outcomes in Postacute Rehabilitation of Older Adults
T2 - A Randomized-Controlled Trial
AU - Lenze, Eric J.
AU - Host, Helen H.
AU - Hildebrand, Mary W.
AU - Morrow-Howell, Nancy
AU - Carpenter, Brian
AU - Freedland, Kenneth E.
AU - Baum, Carolyn A.
AU - Dixon, David
AU - Doré, Peter
AU - Wendleton, Leah
AU - Binder, Ellen F.
N1 - Funding Information:
This study was supported by National Institutes of Health Grant R34 MH083868 .
PY - 2012/10
Y1 - 2012/10
N2 - Objectives: For 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. Design: Randomized controlled trial of Enhanced Medical Rehabilitation versus standard-of-care rehabilitation. Setting: Postacute care unit of a skilled nursing facility in St Louis, MO. Participants: Twenty-six older adults admitted from a hospital for postacute rehabilitation. Intervention: Based 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. Measurements: Therapy 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. Results: Participants 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. Conclusion: Higher 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.
AB - Objectives: For 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. Design: Randomized controlled trial of Enhanced Medical Rehabilitation versus standard-of-care rehabilitation. Setting: Postacute care unit of a skilled nursing facility in St Louis, MO. Participants: Twenty-six older adults admitted from a hospital for postacute rehabilitation. Intervention: Based 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. Measurements: Therapy 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. Results: Participants 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. Conclusion: Higher 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.
KW - Geriatrics
KW - Intensity
KW - Motivation
KW - Nursing home
KW - Post-acute
KW - Rehabilitation
UR - http://www.scopus.com/inward/record.url?scp=84866774045&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2012.06.014
DO - 10.1016/j.jamda.2012.06.014
M3 - Article
C2 - 22863663
AN - SCOPUS:84866774045
SN - 1525-8610
VL - 13
SP - 708
EP - 712
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 8
ER -