Synergizing home health rehabilitation therapy to optimize patients’ activities of daily living

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Project Summary Regaining the ability to take care of oneself after an illness or medical episode is critical for older adults to maintain independent living at home in the community. Each year, 3 to 4.5 million older adults receive home health care services that provide skilled rehabilitation therapy in their home. These patients experience reduced capacity to perform activities of daily living (ADL) independently, which is a significant risk factor for long-term care placement. Recent data has shown that 42% of home health patients do not improve in ADL at discharge. There is currently a lack of evidence-based rehabilitation programs in home health. Increasing activity-based intervention in home health care rehabilitation could be the key to improve patients’ ADL independence. The objective of this R21 application is to pilot test an ADL-enhanced program as an adjuvant therapy to usual home health rehabilitation to improve patients’ ADL outcome. The ADL-enhanced program facilitates patients’ participation in ADL first by lowering the task demand using a compensatory approach. As the patient increases physical capacity as a result of physical therapy services, the ADL-enhanced program shifts to a restorative approach, which increases the task demand to help the patient channel the improved physical capacity to better activity performance. We will implement the activity grading principles to increase task demand, which has been tested in our prior study, in the proposed restorative approach. We found that older adults who practiced daily activities with increased activity demand after exercise have less decline in ADL than older adults who practiced physical exercise only. The ADL-enhanced program is innovative because it manipulates the gradient of activity challenge by delivering the compensatory approach and the restorative approach in sequence over a six-week treatment period. This activity-based paradigm does not exist in current home health care practice. Our central hypothesis is that the ADL-enhanced program will synergize with usual rehabilitation therapy and augment the outcome in ADL. We propose a pilot randomized controlled trial to investigate the preliminary effects of the ADL- enhanced program. Forty-eight home health patients will be randomly assigned to receive the ADL-enhanced program with usual rehabilitation therapy versus usual rehabilitation therapy only. Our specific aims are to: 1) estimate the preliminary effect of the ADL-enhanced program on improving ADL; 2) estimate the preliminary effect of the ADL-enhanced program on improving physical functioning of the upper extremity and the lower extremity; and 3) assess the program completion rate, satisfaction rate, and adverse event rate (e.g., falls and hospital admissions). The proposed project aligns with the NIA’s mission to develop effective interventions to maintain health, well-being, and function as well as to prevent or reduce the burden of age-related disabilities. Research findings will be used to develop a hybrid effectiveness-implementation trial of the ADL-enhanced program, laying the groundwork for potential large-scale implementation in the home health care setting.