Abstract
BackgroundGeriatric patients with cognitive impairment (CI) show an increased risk for a negative rehabilitation outcome and reduced functional recovery following inpatient rehabilitation. Despite this obvious demand, evidence-based training programs at the transition from rehabilitation to the home environments are lacking. The aim of this study is to evaluate the efficacy of a feasible and cost-effective home-based training program to improve motor performance and to promote physical activity, specifically-tailored for post-ward geriatric patients with CI.MethodsA sample of 101 geriatric patients with mild to moderate stage CI following ward-based rehabilitation will be recruited for a blinded, randomized controlled trial with two arms. The intervention group will conduct a 12 week home-based training, consisting of (1) Exercises to improve strength/power, and postural control; (2) Individual walking trails to enhance physical activity; (3) Implementation of patient-specific motivational strategies to promote behavioral changes. The control group will conduct 12 weeks of unspecific flexibility exercise. Both groups will complete a baseline measurement before starting the program, at the end of the intervention, and after 24 weeks for follow-up. Sensor-based as well as questionnaire-based measures will be applied to comprehensively assess intervention effects. Primary outcomes document motor performance, assessed by the Short Physical Performance Battery, and level of physical activity (PA), as assessed by duration of active episodes (i.e., sum of standing and walking). Secondary outcomes include various medical, psycho-social, various PA and motor outcomes, including sensor-based assessment as well as cost effectiveness.DiscussionOur study is among the first to provide home-based training in geriatric patients with CI at the transition from a rehabilitation unit to the home environment. The program offers several unique approaches, e.g., a comprehensive and innovative assessment strategy and the integration of individually-tailored motivational strategies. We expect the program to be safe and feasible in geriatric patients with CI with the potential to enhance the sustainability of geriatric rehabilitation programs in patients with CI.Trial registrationInternational Standard Randomized Controlled Trial (#ISRCTN82378327). Registered: August 10, 2015.
Highlights
Geriatric patients with cognitive impairment (CI) show an increased risk for a negative rehabilitation outcome and reduced functional recovery following inpatient rehabilitation
Our study is among the first randomized-controlled trial (RCT) to investigate a -tailored home-based training program with low entry barriers in geriatric patients with CI at the transition from a rehabilitation unit to their home environment
If the program will prove to be effective, it may lower the barrier for post-ward geriatric patients to take up training and exercising
Summary
Geriatric patients with cognitive impairment (CI) show an increased risk for a negative rehabilitation outcome and reduced functional recovery following inpatient rehabilitation. Patients with CI show an increased risk for negative rehabilitation outcome, leading to limited functional recovery during inpatient rehabilitation [15] and a lower functional status at hospital discharge [5] Their access to medical services is limited, including post-ward rehabilitation (e.g., traveling too far to participate in rehabilitation programs is considered a typical barrier) [16]. These findings indicate the need for appropriate rehabilitation concepts for geriatric patients with CI at the transition from inpatient rehabilitation to their home environments and innovative, individually-tailored training concepts with low entry barriers are required. Effective post-ward rehabilitation programs may increase the ability to perform ADL, representing one of the most important predictor of societal costs of care of community-dwelling patients and improve functional performances and mobility (i.e., allowing proper preservation of autonomy)
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