GOLDEN OLDIE: PATIENT-CENTERED PHYSICAL THERAPY IS (COST-) EFFECTIVE IN INCREASING PHYSICAL ACTIVITY AND REDUCING FRAILTY IN OLDER ADULTS WITH MOBILITY PROBLEMS: A RANDOMIZED CONTROLLED TRIAL WITH 6-MONTHS FOLLOW-UP

Review written by Dr Mariana Wingood info

BACKGROUND & OBJECTIVE

As healthcare providers and exercise experts we regularly promote physical activity (PA). Unfortunately however, our words are rarely converted into action. This is especially true for individuals who are older, have multiple co-morbidities, are experiencing pain, or have limited mobility. To improve PA adherence, healthcare professionals have turned to various Shared Decision Models (SDM), such as the one illustrated in Figure 1. Researchers of this article have used the SDM and the Hypothesis-Oriented Algorithm for Clinicians (HOAC-II) to create Coach2Move, illustrated in Figure 2. The aim of this study is to test the (cost-) effectiveness of the Coach2Move strategy.

Figure 1: Applying the Shared Decision Model to PA Image

Figure 2: The Coach2Move strategy summarized in the HOAC-II cycle (de Vries et al. 2015) Image

METHODS

Design: RCT in 13 physical therapy (PT) practices Subjects:

  • Individuals 70 years and older who had problems with ambulation and signed up for PT.
  • Excluded individuals who were unable to walk 5m, had a MMSE score < 21, unable to understand Dutch, receiving palliative care, had an acute illness requiring hospitalization, residing in a nursing home, had a severe degenerative neurological disease, had a contraindication to being physically active, and had PT for a period longer than 4 weeks during the last 6 months.

Intervention Group: Geriatric PTs applied the Coach2Move strategy. The strategy helped them use a patient-centered approach to identify needs, limitations, and strength in both the patient and the physical and social environment. The information gathered was used to create an individualized evidence-based intervention to promote PA. The type of intervention program was based on the classification of their profile (see Table 1).

Table 1: Profile Classification Image

Control Group: usual care with no instructions on treatment content, frequency, and/or duration of the treatment episode. Outcomes: collected at 3 and 6 months

  • Primary Outcome: Physical Activity Leve
  • Secondary outcomes:
    • Mobility Outcomes: Get Up & Go Test, 6-minute walk test, and gait speed.
    • Quality of life: SF-36
    • Frailty: Evaluative Frailty Index for PA
    • Fatigue: Numeric Fatigue Rating Scale
  • Economic evaluation: a healthcare utilization questionnaire

Image

Coach2Move is a feasible and beneficial approach for promoting physical activity among older adult patients.

RESULTS

See Table 2 and 3.

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