Enhanced Medical Rehabilitation Increases Therapy Intensity and Engagement and Improves Functional Outcomes in Postacute Rehabilitation of Older Adults: A Randomized-Controlled Trial
Open accessAbstract
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.
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Gait speeds at SNF discharge averaged 0.39 m/s, which is less than half of the 1.0 m/s necessary for community ambulation.
“Notably, gait speeds at SNF discharge averaged 0.39 m/s,239 which is less than half of the 1.0 m/s necessary for community ambulation.240”
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- [21]Hildebrand M Host HH Kraus L Lenze E Binder EF Novel methods for increasing and measuring occupational therapy intensity in the skilled nursing rehabilitation setting 2012 Poster presentation at the 2012 AOTA National Conference in Indianapolis, IN Indianapolis, IN
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Forman, D. E., Arena, R., Boxer, R., Dolansky, M. A., Eng, J. J., Fleg, J. L., Haykowsky, M., Jahangir, A., Kaminsky, L. A., Kitzman, D. W., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000483 · Cited by 319 · see citing works
- Authors
- Lenze, E. J., Host, H. H., Hildebrand, M. W., Morrow-Howell, N., Carpenter, B., Freedland, K. E., Baum, C. A., Dixon, D., Doré, P., Wendleton, L., & Binder, E. F.
- Affiliations
- Washington University in St. Louis (US)
- East Carolina University (US)
- Corresponding author
- Lenze, Eric J.
- ORCID
- Venue
- Journal of the American Medical Directors Association
- Publisher
- Elsevier BV
- Published
- 2012-10
- Volume
- 13
- Issue
- 8
- Pages
- 708-712
- ISSN
- 1525-8610 (ISSN-L)
- PMC
- PMC3601780
- OpenAlex
- W2059453496
- Cited by
- 55
- References
- 37
- Citations by year
- 2026: 1 · 2024: 6 · 2023: 4 · 2022: 3 · 2021: 4 · 2020: 4 · 2019: 12 · 2018: 2 · 2017: 6 · 2016: 6 · 2015: 4 · 2014: 3
- FWCI
- 5.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Medical Directors Association (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
- National Institute of Mental Health (R34MH083868)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- post-acute rehabilitation, skilled nursing facilities, older adults, treatment intensity, patient engagement, physiotherapy, occupational therapy, walking speed, functional outcome, Barthel Index, 6-minute walk test
- MeSH terms
- Aged, Aged, 80 and over, Exercise Therapy, Female, Persons with Disabilities, Humans, Male, Missouri, Occupational Therapy, Patient Participation, Skilled Nursing Facilities, Outcome Assessment, Health Care, Recovery of Function
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