The rehabilitation enhancing aging through connected health (REACH) study: study protocol for a quasi-experimental clinical trial

Abstract

BackgroundMobility limitations among older adults increase the risk for disability and healthcare utilization. Rehabilitative care is identified as the most efficacious treatment for maintaining physical function. However, there is insufficient evidence identifying a healthcare model that targets prevention of mobility decline among older adults. The objective of this study is to evaluate the preliminary effectiveness of a physical therapy program, augmented with mobile tele-health technology, on mobility function and healthcare utilization among older adults.MethodsThis is a quasi-experimental 12-month clinical trial conducted within a metropolitan-based healthcare system in the northeastern United States. It is in parallel with an existing longitudinal cohort study evaluating mobility decline among community-dwelling older adult primary care patients over one year. Seventy-five older adults (≥ 65–95 years) are being recruited using identical inclusion/exclusion criteria to the cohort study. Three aims will be evaluated: the effect of our program on 1) physical function, 2) healthcare utilization, and 3) healthcare costs. Changes in patient-reported function over 1 year in those receiving the intervention (aim 1) will be compared to propensity score matched controls (N = 150) from the cohort study. For aims 2 and 3, propensity scores, derived from logistic regression model that includes demographic and diagnostic information available through claims and enrollment information, will be used to match treatment and control patients in a ratio of 1:2 or 1:3 from a Medicare Claims Registry derived from the same geographic region. The intervention consists of a one-year physical therapy program that is divided between a combination of outpatient and home visits (6–10 total visits) and is augmented on a computerized tablet using of a commercially available application to deliver a progressive home-based exercise program emphasizing lower-extremity function and a walking program.DiscussionIncorporating mobile health into current healthcare models of rehabilitative care has the potential to decrease hospital visits and provide a longer duration of care. If the hypotheses are supported and demonstrate improved mobility and reduced healthcare utilization, this innovative care model would be applicable for optimizing the maintenance of functional independence among community-dwelling older adults.Trial registrationClinicalTrial.gov Identifier: NCT02580409 (Date of registration October 14, 2015).

Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019

“… 11 , 12 , 13 Furthermore, rehabilitation provided close to people's homes helps them do better and remain in education and the workforce, as well as remain independent for longer, leading to substantial cost benefits for both the individual and society. 34 , 35 People with chronic health conditions require long-term rehabilitation services which, if not accessible at the primary care level, can leave them behind. Also, as populations are expected to age, the need for long-term care is going to increase, especially in low-resource settings where already a large part of the world's ageing population lives.…”

Perceptions from People Aging with a Mobility Impairment towards using Tele-Technology for Exercise

“…The use of Tai Chi exercise in conjunction with teletechnology for aging adults has shown great promise. Technology-facilitated programs have been beneficial for older with mobility decline (Ni et al, 2017), pre-frail older adults (Marit Dekker-van et al, 2017), and those living in geographically rural areas (Elder et al, 2016). Previous findings indicate that study participants demonstrate approving views of tai chi tele-exercise classes and interest in long-term use (Wu et al, 2010;Wu et al, 2006;Mitzner et al, 2017).…”

Maintenance Physical Therapy

“…Researchers indicate that a decline in function is linked with disability development, nursing home placement, and hospitalization in aging adults. [22][23][24][25][26] Growing evidence supports that measuring physical performance over time using a tool such as the SPPB (Short Form Physical Performance Battery) can predict functional decline. If abnormalities in these vital signs for dismobility are identified early and intervention initiated, mobility disability and subsequent institutionalization could be avoided.…”

“…31,32 Empirical evidence suggests that a minimal number of prehabilitative physical therapist visits over a lengthened period of time could prevent impairment and performance-based issues that lead to future disability. 22,[33][34][35][36] Gill and colleagues 37 determined the effectiveness of impairment-based home physical therapist intervention on selfreported physical disability and nursing home placement in frail community-dwelling older adults. Interventions averaged 14.9 ± 2.4 visits over the course of 6 months, followed by 6 months of monthly telephone calls.…”