The effect of physical rehabilitation on activities of daily living in older residents of long-term care facilities: systematic review with meta-analysis

Crocker, Thomas F; Young, John; Forster, Anne; Brown, Lesley; Ozer, Seline; Greenwood, Darren C.

doi:10.1093/ageing/aft133

Cited by 68 publications

(67 citation statements)

References 23 publications

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“…For all scales, the 0 category indicated the absence of ADL impairment, cognitive impairment, depression, or pain. For the ADL Hierarchy scale and the CPS, the remaining categories were mild (score of 1-2), moderate (3)(4), and severe (5-6) ADL or cognitive impairment; for the pain scale, daily mild to moderate pain (1-2) and daily excruciating pain (3); and for the DRS, mild depression (1-2) and evidence of depression (3þ). When entering the scales into the simple logistic regression, we used the 0 category (no impairment, depression, or pain) as the reference value.…”

Section: Methodsmentioning

confidence: 99%

“…3 A recent Cochrane review concluded that physical rehabilitation can maintain and improve the physical function and quality of life (QOL) of residents in LTC. 4 In addition, physical therapists can function as part of an integrated team to manage pain, 5,6 pressure ulcers, 7 urinary incontinence, 8 and falls. 9 Although PT plays an important role in LTC, there is evidence of regional variation in the amount of rehabilitation resources allocated to LTC residents, both in Canada and around the world.…”

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confidence: 99%

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Who Receives Rehabilitation in Canadian Long-Term Care Facilities? A Cross-Sectional Study

McArthur¹,

Hirdes

Berg

et al. 2015

Physiotherapy Canada

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Purpose: To describe the proportion of residents receiving occupational therapy (OT) and physical therapy (PT) and the factors associated with receiving PT in long-term care (LTC) facilities across five provinces and one territory in Canada. Methods: Using a population-based, retrospective analysis of crosssectional data, the proportion of LTC facility residents in each province or territory receiving three different amounts (time and frequency) of PT, OT, or both before July 1, 2013, was calculated according to the Resource Utilization Groups-III rehabilitation classifications. Twenty-three variables from the Resident Assessment Instrument 2.0, such as age and cognition, were examined as correlates; those significant at p < 0.01 were included in a multivariate logistic regression. Results: Between 63.7% and 88.6% of residents did not receive any PT or OT; 0.8%-12.6% received both PT and OT; 5.8%-29.5% received an unspecified amount of PT; 1.9%-7.0% received 45 minutes or more of PT 3 days or more per week; and fewer than 1% received 150 minutes or more of PT on 5 or more days per week. Province, age, cognitive status, depression, clinical status, fracture, multiple sclerosis, and self-rated potential for improvement were associated with PT irrespective of time intensity. Conclusions: The proportion of LTC residents receiving rehabilitation services varies across Canada and appears to be associated with physical impairments and the potential for improvement; older residents with cognitive impairment or mood disorders are less likely to receive rehabilitation services. Future recommendations should consider what is driving the patterns of service use, determine whether the resources available are appropriate, and address the most appropriate goals for residents in LTC.Key Words: aged; long-term care; occupational therapy; rehabilitation. RÉ SUMÉObjet: Dé crire la proportion de ré sidents qui reç oivent des soins d'ergothé rapie (ET) et de physiothé rapie (PT) ainsi que les facteurs associé s à la ré ception de soins de PT dans des é tablissements de soins de longue de cinq provinces et d'un territoire au Canada. Mé thodes: À l'aide d'une analyse ré trospective de donné s transversales fondé e sur la population, la proportion de ré sidents des é tablissements de soins de longue duré e dans chaque province ou territoire qui recevaient trois combinaisons diffé rentes (temps et fré quence) de soins de PT ou d'ET avant le 1 er juillet 2013 a é té calculé e en fonction des groupes d'utilisation des ressources-classifications de ré adaptation III. Un total de 23 variables de la mé thode d'é valuation RAI 2.0, comme l'â ge et la cognition, ont é té examiné es en tant que corré lats; les variables significatives au seuil de p < 0.01 ont é té incluses dans une ré gression logistique à variables multiples. Ré sultats: De 63,7% à 88,6% des ré sidents n'ont pas reç u de soins de PT ou d'ET; de 0,8% à 12,6% des ré sidents ont reç u les deux types de soins; de 5,8% à 29,5% des ré sidents ont reç u une quantité non pré c...

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Who Receives Rehabilitation in Canadian Long-Term Care Facilities? A Cross-Sectional Study

McArthur¹,

Hirdes

Berg

et al. 2015

Physiotherapy Canada

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“…Promoting progressive mobility includes supporting dignity, especially with incontinence prevention using protective apparel. 20 In the acute care setting, including patients in their routine daily care of donning apparel and toileting routines promotes an early emphasis on self-care and achieving independence.…”

Section: Transitional Care Daily Routinesmentioning

confidence: 99%

“…18 Hemodynamic stability goals are clearly defined and communicated among all team members to ensure safety and maximal benefit from interventions. 20 Acceptable ranges of exercise parameters are established by the nurse practitioner and followed by the rehabilitation therapist and nurse. Team communication strategies include providing team members with direct access to the nurse practitioner via electronic texting and reducing elapsed time between residents' response and the nurse practitioner's intervening orders.…”

Section: Functional Mobility In Transitional Carementioning

confidence: 99%

Progressive Mobility As a Team Effort in Transitional Care

Ecklund¹,

Bloss

2015

Critical Care Nurse

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With changing health care, progressive care nurses are working in diverse practice settings to meet patient care needs. Progressive care is practiced along the continuum from the intensive care unit to home. The benefits of early progressive mobility are examined with a focus on the interdisciplinary collaboration for care in a transitional care program of a skilled nursing facility. The program's goals are improved functional status, self-care management, and home discharge with reduced risk for hospital readmission. The core culture of the program is interdisciplinary collaboration and team partnership for care of patients and their families. (Critical Care Nurse. 2015;35[3]:62-68)

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“…47,[48][49][50][51] The evidence relating specifically to stroke survivors living in care homes is extremely limited. A systematic review considering the efficacy of providing OT to stroke survivors living in care homes was conducted by our research team.…”

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confidence: 99%

An Occupational Therapy intervention for residents with stroke-related disabilities in UK Care Homes (OTCH): cluster randomised controlled trial with economic evaluation

Sackley

Walker

Burton

et al. 2016

Health Technol Assess

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Background Care home residents with stroke-related disabilities have significant activity limitations. Phase II trial results suggested a potential benefit of occupational therapy (OT) in maintaining residents’ capacity to engage in functional activity. Objective Evaluate clinical and cost effectiveness of a targeted course of OT in maintaining functional activity and reducing further health risks from inactivity for UK care home residents living with stroke-related disabilities. Design Pragmatic, parallel-group, cluster randomised controlled trial with economic evaluation. Cluster randomisation occurred at the care home level. Homes were stratified according to trial administrative centre, and type of care provided (nursing or residential) and randomised 1:1 to either the intervention or control arm. Setting 228 care homes local to 11 trial administrative centres across England and Wales. Participants 1042 care home residents with a history of stroke or transient ischaemic attack, including residents with communication and cognitive impairments, not receiving end of life care. 114 care homes (n=568 residents) were allocated to the intervention arm; 114 homes (n=474 residents) to the control arm. Randomisation of participating homes occurred between May 2010 and March 2012. Intervention Personalised three-month course of OT delivered by qualified therapists. Care workers participated in training workshops to support personal activities of daily living. The control condition consisted of usual care for residents. Main outcome measures Primary outcome at the participant level: Barthel Index of Activities of Daily Living at three months. Secondary outcomes at the participant level: Barthel Index scores at six and twelve months post-randomisation, and the Rivermead Mobility Index, Geriatric Depression Scale-15, and EuroQol EQ-5D-3L questionnaire at all time-points. An economic evaluation examined the incremental cost per quality-adjusted life year (QALY) gain, costs were estimated from the perspective of the NHS and personal social services. Results Participants mean age= 82.9 years, 665/1042 (64%) were female. 2538 OT sessions were delivered to 498 participants in the intervention group (mean visits/participant =5.1, SD=3.0). No adverse events attributable to the intervention were recorded. The primary outcome showed no significant differences between groups. The adjusted mean difference in the Barthel Index score between groups was 0.19 points higher in the intervention arm (95% CI -0.33 to 0.70, p=0.48, adjusted ICC 0.09). Secondary outcome measures showed no significant differences at all time-points. Mean incremental cost of the OTCH intervention was £438.78 (CI £-360.89 to £1238.46), and the incremental QALY gain was 0.009 (CI -0.030 to 0.048). Conclusion A three-month individualised course of OT, showed no benefit in maintaining functional activity in an older care home population with stroke-related disabilities. Limitations A high proportion of participants with very severe activity-based limitations and cog...

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The effect of physical rehabilitation on activities of daily living in older residents of long-term care facilities: systematic review with meta-analysis

Abstract: physical rehabilitation may improve independence for elderly long-term care facility residents, but mean effects are small. It is unclear which interventions are most appropriate.

Cited by 68 publications

References 23 publications

Who Receives Rehabilitation in Canadian Long-Term Care Facilities? A Cross-Sectional Study

Who Receives Rehabilitation in Canadian Long-Term Care Facilities? A Cross-Sectional Study

Progressive Mobility As a Team Effort in Transitional Care

An Occupational Therapy intervention for residents with stroke-related disabilities in UK Care Homes (OTCH): cluster randomised controlled trial with economic evaluation

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