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
List of abbreviations:
BMI (body mass index), Boston RISE (Boston Rehabilitative Impairment Study of the Elderly), ED (emergency department), LLWS (Live Long Walk Strong), LLFDI (Late Life Function and Disability Instrument), PT (physical therapist), REACH (Rehabilitation Enhancing Aging through Connected Health), SPPB (Short Physical Performance Battery)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 29, 2019
Footnotes
Disclosures: none.
Supported by the National Institute on Aging (grant no. R01 AG032052-03) and the National Center for Research Resources in a grant to the Harvard Clinical and Translational Science Center (grant no. 1 UL1 RR025758-01); the National Institutes of Health (award no. 1K24HD070966-01); and the RX Foundation. The sponsors had no role in the design, methods, subject recruitment, data collections, analysis, and preparation of the manuscript.
Clinical Trial Registration No.: NCT02580409.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
