The Rehabilitation Enhancing Aging Through Connected Health Prehabilitation Trial



      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.


      Quasi-experimental 12-month clinical trial.


      Two outpatient rehabilitation centers.


      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).


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


      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.


      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.


      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.


      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cummings S.R.
        • Studenski S.
        • Ferrucci L.
        A diagnosis of dismobility-giving mobility clinical visibility: a mobility working group recommendation.
        JAMA. 2014; 311: 2061-2062
        • Graves J.E.
        • Pollock M.L.
        • Jones A.E.
        • Colvin A.B.
        • Leggett S.H.
        Specificity of limited range of motion variable resistance training.
        Med Sci Sports Exerc. 1989; 21: 84-89
        • Guralnik J.M.
        • Ferrucci L.
        • Pieper C.F.
        • et al.
        Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery.
        J Gerontol A Biol Sci Med Sci. 2000; 55: M221-M231
        • Studenski S.
        • Perera S.
        • Wallace D.
        • et al.
        Physical performance measures in the clinical setting.
        J Am Geriatr Soc. 2003; 51: 314-322
        • Fried T.R.
        • Tinetti M.E.
        • Iannone L.
        • O'Leary J.R.
        • Towle V.
        • Van Ness P.H.
        Health outcome prioritization as a tool for decision making among older persons with mutliple chronic conditions.
        Arch Intern Med. 2011; 171: 1854-1856
        • Gill T.M.
        • Baker D.I.
        • Gottschalk M.
        • et al.
        A prehabilitation program for physically frail community-living older persons.
        Arch Phys Med Rehabil. 2003; 84: 394-404
        • Gill T.M.
        • Baker D.I.
        • Gottschalk M.
        • Peduzzi P.N.
        • Allore H.
        • Byers A.
        A program to prevent functional decline in physically frail, elderly persons who live at home.
        N Engl J Med. 2002; 347: 1068-1074
        • Brown L.G.
        • Ni M.
        • Schmidt C.T.
        • Bean J.F.
        Evaluation of an outpatient rehabilitative program to address mobility limitations among older adults.
        Am J Phys Med Rehabil. 2017; 96: 600-606
        • Ellis T.D.
        • Cavanaugh J.T.
        • DeAngelis T.
        • et al.
        Comparative effectiveness of mHealth-supported exercise compared to exercise alone for people with Parkinson disease: randomized controlled pilot study.
        Phys Ther. 2019; 99: 203-216
        • Latham N.K.
        • Harris B.A.
        • Bean J.F.
        • et al.
        Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial.
        JAMA. 2014; 311: 700-708
        • Ni M.
        • Brown L.G.
        • Lawler D.
        • et al.
        The rehabilitation enhancing aging through connected health (REACH) study: study protocol for a quasi-experimental clinical trial.
        BMC Geriatr. 2017; 17: 221
        • Holt N.E.
        • Percac-Lima S.
        • Kurlinski L.A.
        • et al.
        The Boston Rehabilitative Impairment Study of the Elderly: a description of methods.
        Arch Phys Med Rehabil. 2013; 94: 347-355
        • Fried L.P.
        • Bandeen-Roche K.
        • Chaves P.H.
        • Johnson B.A.
        Preclinical mobility disability predicts incident mobility disability in older women.
        J Gerontol A Biol Sci Med Sci. 2000; 55: M43-M52
        • Beauchamp M.K.
        • Schmidt C.T.
        • Pedersen M.M.
        • Bean J.F.
        • Jette A.M.
        Psychometric properties of the Late-Life Function and Disability Instrument: a systematic review.
        BMC Geriatr. 2014; 14: 12
        • Beauchamp M.K.
        • Ward R.E.
        • Jette A.M.
        • Bean J.F.
        Meaningful change estimates for the Late-Life Function Instrument in older adults.
        J Gerontol A Biol Sci Med Sci. 2019; 74: 556-559
        • Haley S.M.
        • Jette A.M.
        • Coster W.J.
        • et al.
        Late Life Function and Disability Instrument: II. Development and evaluation of the function component.
        J Gerontol A Biol Sci Med Sci. 2002; 57: M217-M222
        • Sangha O.
        • Stucki G.
        • Liang M.H.
        • Fossel A.H.
        • Katz J.N.
        The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research.
        Arthritis Rheum. 2003; 49: 156-163
        • Powell L.E.
        • Myers A.M.
        The Activities-specific Balance Confidence (ABC) Scale.
        J Gerontol A Biol Sci Med Sci. 1995; 50A: M28-M34
        • Ward R.E.
        • Beauchamp M.K.
        • Latham N.K.
        • et al.
        Neuromuscular impairments contributing to persistently poor and declining lower-extremity mobility among older adults: new findings informing geriatric rehabilitation.
        Arch Phys Med Rehabil. 2016; 97: 1316-1322
        • Beauchamp M.K.
        • Jette A.M.
        • Ward R.E.
        • et al.
        Predictive validity and responsiveness of patient-reported and performance-based measures of function in the Boston RISE study.
        J Gerontol A Biol Sci Med Sci. 2015; 70: 616-622
        • Lunt M.
        Selecting an appropriate caliper can be essential for achieving good balance with propensity score matching.
        Am J Epidemiol. 2014; 179: 226-235
        • Kwon S.
        • Perera S.
        • Pahor M.
        • et al.
        What is a meaningful change in physical performance? Findings from a clinical trial in older adults (the LIFE-P study).
        J Nutr Health Aging. 2009; 13: 538-544
        • Perera S.
        • Mody S.H.
        • Woodman R.C.
        • Studenski S.A.
        Meaningful change and responsiveness in common physical performance measures in older adults.
        J Am Geriatr Soc. 2006; 54: 743-749
        • Consumer Health Ratings
        Emergency room-typical average cost of hospital ED visit.
        (Available at:) (Accessed July 20, 2018)
        • Nagurney J.M.
        • Fleischman W.
        • Han L.
        • Leo-Summers L.
        • Allore H.G.
        • Gill T.M.
        Emergency department visits without hospitalization are associated with functional decline in older persons.
        Ann Emerg Med. 2017; 69: 426-433
        • Sri-On J.
        • Tirrell G.P.
        • Bean J.F.
        • Lipsitz L.A.
        • Liu S.W.
        Revisit, subsequent hospitalization, recurrent fall, and death within 6 months after a fall among elderly emergency department patients.
        Ann Emerg Med. 2017; 70: 516-521
        • Bauman A.
        • Merom D.
        • Bull F.C.
        • Buchner D.M.
        • Fiatarone Singh M.A.
        Updating the evidence for physical activity: summative reviews of the epidemiological evidence, prevalence, and interventions to promote “active aging”.
        Gerontologist. 2016; 56: S268-S280
        • Szanton S.L.
        • Alfonso Y.N.
        • Leff B.
        • et al.
        Medicaid cost savings of a preventive home visit program for disabled older adults.
        J Am Geriatr Soc. 2018; 66: 614-620
        • Szanton S.L.
        • Leff B.
        • Wolff J.L.
        • Roberts L.
        • Gitlin L.N.
        Home-based care program reduces disability and promotes aging in place.
        Health Aff (Millwood). 2016; 35: 1558-1563
        • Chang F.H.
        • Latham N.K.
        • Ni P.
        • Jette A.M.
        Does self-efficacy mediate functional change in older adults participating in an exercise program after hip fracture? A randomized controlled trial.
        Arch Phys Med Rehabil. 2015; 96: 1014-1020