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Arch Phys Med Rehabil. 2019 May 29. pii: S0003-9993(19)30380-6. doi: 10.1016/j.apmr.2019.04.015. [Epub ahead of print]

The Rehabilitation Enhancing Aging Through Connected Health Prehabilitation Trial.

Author information

1
New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA; Harvard Medical School, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA. Electronic address: Jonathan.bean4@va.gov.
2
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.
3
College of Health and Rehabilitation Sciences: Sargent, Boston University, Boston, MA.
4
Heller School for Social Policy and Management, Brandeis University, Waltham, MA.
5
New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA.
6
Bloomsburg University of Pennsylvania, Bloomsburg, PA.

Abstract

OBJECTIVE:

To 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.

DESIGN:

Quasi-experimental 12-month clinical trial.

SETTING:

Two outpatient rehabilitation centers.

PARTICIPANTS:

Community-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).

INTERVENTION:

Combined outpatient and home PT augmented with a commercially available app and computer tablet.

MEASUREMENTS:

Primary 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.

RESULTS:

Among 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.

CONCLUSION:

The 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

PMID:
31152705
DOI:
10.1016/j.apmr.2019.04.015

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