Clinical Outcome Variables Scale Research Articles

PHYSICAL THERAPY IS AN INTEGRAL PART OF THE SURGICAL TREATMENT OF VALGUS DEFORMITY OF THE FIRST TOE

Objective. Determining the effectiveness of physical therapy in the surgical treatment of valgus deformity of the first toe. Methods. The clinical material of the conducted study includes 38 observations, 34 patients (38 operative interventions, 4 patients — on 2 feet. In the control group (CG) there were 16 patients (16 interventions), and in the main group (MG) — 18 patients (22 interventions). All patients who participated in the study had the same diagnosis — hallux valgus II–III degree. All patients received the same type of surgical intervention — a variant Z-shaped osteotomy of the first metatarsal bone according to the Scarf method or Chevron, which was supplemented with osteotomy of proximal phalanges of the I finger to Akin method. Patients were examined with the Visual-Analogue Scale (VAS), the Physiotherapy Clinical Outcome Variables (COVS) Motor Skills Testing Scale, and the American Orthopedic Foot and Ankle Society (AOFAS) Scale (module 2) for the Clinical Evaluation of Foot and Ankle Diseases of the American Foot and Ankle Association. Rehabilitation of MG patients consisted of developed physical therapy (PT) program, which included 4 periods. Rehabilitation included not only massage and exercises for the muscles of the front part of the foot, but also a complex of rehabilitation methods aimed to restore the function of the muscles of both lower limbs, hips and buttocks. PT program for KG consisted only of morning hygienic gymnastics, classical massage and therapeutic exercises to restore function of muscles of the foot and lower leg. Results. Assessment of the condition of patients after the end of PT on the COVS scale helped to conclude that the patients of MG have significantly better indicators of general physical activity than patients of CG. Analysis of the obtained results according to the (AOFAS) Scale confirmed that patients of MG after using developed PT program have statistically better results. Conclusions. The developed PT program significantly accelerate the clinical recovery of function not only the front part of the foot, but also general working capacity of patients.

Reliability of the Clinical Outcome Variables Scale for children with cerebral palsy

Background/aims It can be difficult for rehabilitation professionals to use lengthy scales and different outcome measures for diverse clinical conditions in busy outpatient settings. The Clinical Outcome Variables Scale is a functional mobility measure that is applied to various neurological conditions. Determining the inter- and intra-rater reliability of clinical outcome variable scale for children with cerebral palsy will further enhance its utility. Methods A total of 30 children aged between 3 and 16 years with cerebral palsy, who could obey single-step commands, were recruited for the study. Two independent assessors scored the children using the Clinical Outcome Variable Scale to determine inter-rater reliability. A repeat assessment was done by the principal assessor after 24 hours to establish intra-rater reliability. Reliability was estimated using intra-class correlation coefficient values. Results The Clinical Outcome Variables Scale had high Inter- and intra-rater reliability for the composite score (intraclass correlation coefficient=1), the general mobility subscale (intraclass correlation coefficient=0.99), and the ambulation subscale (intraclass correlation coefficient=0.99). The intraclass correlation coefficient for the individual test items were also showed a high correlation, with the variance between the tests and physiotherapists ranging from 0.95 to 1. Conclusions The Clinical Outcome Variables Scale demonstrated high inter- and intra-rater reliability when assessing functional mobility in children with cerebral palsy. Further studies should establish criterion validity and minimally clinically important difference values to maximise the use of the scale.

Diagnostic tools of intensive care unit acquired weakness: a systematic review

To explore effective and objective diagnostic tools for evaluating intensive care unit acquired weakness (ICUAW). The studies about evaluation and diagnosis of adult ICUAW in PubMed, Embase, Web of Science, the Cochrane Library, CNKI, CBM, VIP and Wanfang databases from the date of their foundation to July 1st in 2018 were retrieved by computer. The literatures in Chinese and English were searched. Two investigators independently screened literature and evaluated the literature quality ratings, and extracted the research design, sample size, research object, evaluation item, reliability, validity, clinical application and other indicators, and then systematically analyzed the reliability and validity of ICUAW diagnostic tools, and evaluated diagnostic tools' advantages, disadvantages and application status. There were 19 literatures including 14 assessment scales and ultrasound diagnosis. The 14 assessment scales were medical research council score (MRC-Score), Barthel index (BI), 6-minute walk test (6MWT), clinical outcome variables scale (COVS), the Chelsea critical care physical assessment tool (CPAx), functional independence measure (FIM), functional status score for the intensive care unit (FSS-ICU), the ICU mobility scale (IMS), rivermead mobility index (RMI), the Perme ICU score (PERME), the physical function ICU test (PFIT), the physical function ICU test score (PFIT-s), the surgical ICU optimal mobility score (SOMS), and the Manchester mobility score (MMS). Nine scales (60%) were tested reliability and the rang of inter-rater reliability was 0.600-0.996, and the test reliability was 0.970, and the range of internal consistency reliability was 0.680-0.992. Validity of 6 scales (40%) were evaluated, and the range of structure validity was 0.57-0.94, the range of content validity was 0.830-0.988, the range of concurrent validity was 0.730-0.823. It was shown that the reliability of ICUAW assessment scale was relatively good at present, but the degree of accurate assessment of ICUAW was relatively low. The evaluation content of ICUAW can be divided into three categories: in the first, they measured the muscles strength of body just like MRC-Score; in the second, they evaluated the physical function and mobility, such as COVS, CPAx, FIM, FSS-ICU, IMS, PERME, PFIT, RMI, SOMS and MMS; in the third, they evaluated daily activity and physiology parameter just as 6MWT, BI and ultrasound. Different scales were correlated with the length of ICU stay (ICU-LOS), the hospital discharge, and the mortality. For example: COVS, CPAx, FSS-ICU, PFIT, PFIT-s and SOMS could predict the ICU-LOS and hospital discharge, RMI and SOMS can predict patient mortality. However, there was no evidence to testify the consistency between them. Now, the specialist consensus about the observation nodes of threshold and electrophysiological records were the complex action potential (CMAP) range < 0.43-0.65 mV and the sensory nerve action potential (SNAP) range < 17.6 μV. There are many diagnostic tools in ICUAW, and the reliability of each scale is relatively good. In future studies, we should collect the advantages of each scale, explore the specific indicators to evaluate ICUAW and improve the accuracy and validity of diagnostic ICUAW.

Effects of weight-shift training on walking ability, ambulation, and weight distribution in individuals with chronic stroke: a pilot study

Background: People with gait difficulties after a stroke usually have an asymmetrical gait and slower gait speed than age-matched controls. These difficulties restrict people with stroke in their daily life activities.Objective: This pilot study sought to evaluate the effects of weight-shift training on gait, weight distribution in standing, and ambulation in people with gait difficulties after a stroke.Methods: Ten subjects with chronic stroke (3–11 years since insult) and remaining gait difficulties participated in a 3-week weight-shift training program. Spatial and temporal gait parameters were assessed pre-, post-, and 3-month post-training with a motion analysis system. Weight distribution was assessed with force plates and ambulation with the Swedish version of the Clinical Outcome Variables Scale (S-COVS). Wilcoxon signed-rank tests were used to explore differences between test occasions.Results: Significant changes were seen between pre-and post-tests in decreased stance time on the non-paretic leg (P = 0.005) and increased score on the S-COVS (P = 0.043). At the 3-month follow-up test, the subjects had also increased their gait speed significantly (P = 0.037). Standing weight distribution did not change between pre- and post-tests (P = 0.575), but between the pre-and follow-up tests it shifted from the paretic leg to the non-paretic (P = 0.007).Conclusion: Weight-shift training seems to improve gait and ambulation in subjects with chronic stroke, but not with standing weight distribution. However, this pilot study has several limitations and a larger sample size with a control group is necessary.

Is the Recovery of Functional Balance and Mobility Accompanied by Physiological Recovery in People With Severe Impairments After Stroke?

Background. Rehabilitation after severe stroke is often limited because of impairments in sensorimotor function. Functional and physiological recovery after severe stroke is poorly understood and has not been studied extensively. Objective. This study’s purpose was to examine functional and physiological recovery of standing balance during inpatient rehabilitation in people with severe impairments after stroke. Methods. A total of 10 participants with severe impairments after stroke were evaluated monthly in a stroke rehabilitation unit with the following functional outcome measures: Berg Balance Scale (BBS), Clinical Outcome Variables Scale (COVS), and Chedoke McMaster Stroke Assessment (CMSA). Weight bearing (WB), center of pressure (COP) velocity, and electromyography (EMG) data were collected during quiet standing and during internal perturbation with a rapid nonparetic arm raise. Results. Cross-sectionally, there were moderate to strong correlations for EMG area and WB with CMSA and COVS. Additionally, the BBS was correlated with WB on the paretic side. Longitudinally, statistically significant improvement was found for functional measures but not for physiological measures. The mean BBS and COVS improved by 23 and 21 points, respectively. COP velocity decreased by 60.1% on the paretic leg but not significantly. Conclusions. During stroke rehabilitation, all participants improved functionally. Some patients improved physiologically, though near discharge, all participants remained very impaired. Future studies with larger sample sizes are needed to explore the capacity for physiological recovery in this population.

A Longitudinal Study of Physical Function in Patients with Early-Onset Dementia

Background: The aim of this study was to explore changes in mobility in terms of ambulation and transfer over 1 year in patients with early-onset Alzheimer’s disease (EOAD), and to compare mobility in EOAD with patients with other types of early-onset dementia (EOOD). Method: Forty-two patients with EOAD and 30 patients with EOOD were included. All patients were home-dwelling and had mild or moderate degree of dementia. Mobility was assessed using the Timed Up and Go Test (TUG), a modified version of the Clinical Outcome Variables Scale, timed stair walking, and timed rise from the floor. Results: The EOAD group performed significantly better than the EOOD group on all mobility tests. After 1 year, 25 persons with EOAD were tested again. The performance on TUG (p = 0.028) and stair walking (p = 0.02) had deteriorated at the 1-year follow-up in the EOAD group. Conclusion: Patients with EOAD performed better on mobility tasks than patients with EOOD, but their performance deteriorated at 1-year follow-up.

Clinical Outcome Variables Scale: A retrospective validation study in patients after stroke

The construct, predictive and longitudinal validity of the Clinical Outcome Variables Scale (COVS), an assessment of functional mobility, was examined in relation to measures of functional disability (Functional Independence Measure (FIMTM)), balance (Berg Balance Scale (BBS)) and length of stay in inpatient stroke rehabilitation. Associations between admission and discharge scores on each measure were examined retrospectively for 134 patients admitted for inpatient stroke rehabilitation. The association between admission scores and length of stay was tested using a simple linear regression. Paired t-tests and standardized response means were calculated to examine longitudinal validity. COVS scores were correlated with FIM and BBS scores at admission (rho = 0.823 and 0.895, respectively) and discharge (rho = 0.771 and 0.895, respectively). Admission COVS, FIM and BBS scores were correlated with length of stay (rho = -0.61, -0.69 and -0.61, respectively; p < 0.01). A significant (p < 0.01) linear association was demonstrated between admission scores and length of stay. All measures demonstrated significant change over time. Standardized response means were 1.23, 1.16 and 1.36 for the COVS, BBS and FIM, respectively. Within a subset of rehabilitation patients with stroke, the COVS demonstrated construct, predictive and longitudinal validity. The COVS provides a comprehensive assessment of functional mobility and should be evaluated further for its usefulness in stroke rehabilitation.

Validation of the activity inventory of the Chedoke-McMaster stroke assessment and the clinical outcome variables scale to evaluate mobility in geriatric clients

To evaluate the construct validity of the Activity Inventory of the Chedoke-McMaster Stroke Assessment and the Clinical Outcome Variables Scale (COVS), 2 measures of functional mobility. A retrospective longitudinal study of 24 inpatients (mean age 83 years (standard deviation 7)) on a geriatric rehabilitation unit. The primary reasons for admission were deconditioning (n=9) and hip fracture (n=7). We tested hypotheses that Activity Inventory and COVS scores at admission and discharge, and change scores during hospital stay would correlate. Longitudinal construct validity was also estimated using effect size and standardized response mean. Correlations between scores on each measure ranged from r=0.59-0.93 across subscales and total scales (p<0.01). The effect size of the Activity Inventory and the COVS was 1.53 and 1.43, respectively. The standardized response mean of the Activity Inventory and the COVS was 1.83 and 2.30, respectively. Although findings support the validity of both measures, the COVS appears more efficient and sensitive than the Activity Inventory to change in this population. A larger study is needed to confirm these findings.

Standardization of the Continuing Care Activity Measure: A Multicenter Study to Assess Reliability, Validity, and Ability to Measure Change

There is a lack of standardized mobility measures specific to the long-term care (LTC) population. Therefore, the Continuing Care Activity Measure (CCAM) was developed. This study determined levels of reliability, validity for clinical utilization, and sensitivity to change of this measure. This was a prospective longitudinal cohort study among elderly people with primarily physical or medical impairments who were residing in LTC institutions that provide nursing home and more-complex care, with access to physical therapy services. The CCAM, the Clinical Outcome Variables Scale (COVS), the Social Engagement Scale (SES) of the Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 instrument, and the Resource Utilization Groups, version 3, (RUG-III) were administered by clinical and research physical therapists, with timing dictated by the study purpose. The participants were 136 residents of LTC institutions and 21 physical therapists. The CCAM interrater reliability (intraclass correlation coefficient [ICC]) was .97 (95% confidence interval=.91-1.00), and test-retest reliability (ICC) over a period of 1 week was .99 (95% confidence interval=.93-1.00). Over 6 months, the absolute change in total score was 5.88 for the CCAM and 4.26 for the COVS; the CCAM was 28% more responsive across all participants (n=105) and 68% more responsive for those scoring in the lower half (n=49). The minimal detectable difference of the CCAM was 8.6 across all participants. The CCAM correlated with the COVS, nursing care hours inferred from the RUG-III, and the SES. Some participants were lost to follow-up. The CCAM is a reliable and valid tool to measure gross motor function and physical mobility for elderly people in LTC institutions. It discriminates among functional levels, measures individual functional change, and can contribute to clinical decision making.

Assessment of sitting balance of patients with stroke undergoing inpatient rehabilitation

Accurate clinical assessment of sitting is required to develop appropriate treatment programs and evaluate outcomes, but no set tool for measuring sitting balance has been commonly accepted. The purpose of this study was to evaluate the ability of the sitting balance items of the Berg Balance Scale (BBS) and the Clinical Outcome Variables Scale (COVS) to show a clinical change following rehabilitation of patients with subacute stroke. A retrospective audit of 51 patients with stroke who underwent inpatient rehabilitation was conducted. Frequency distributions were used to evaluate ceiling and floor effects. Change in sitting balance was evaluated by using the Wilcoxon test, and effect size was calculated. The results showed that the mean age of the sample was 72 (SD=11.3) years, 57% were males, and 52% were admitted for rehabilitation within 30 days of their stroke. Frequency distributions showed significant ceiling effect only for the BBS sitting item. There was a significant change in the COVS sitting scores (effect size=0.46; p < 0.001), but not for the BBS (effect size=0.22; p=0.102). The results of this study suggest that the sitting item of the COVS may provide a measure of sitting balance for the inpatient stage of rehabilitation after stroke.

The physiotherapy clinical outcome variables scale predicts length of hospital stay, discharge destination and future home facility in the acute comprehensive stroke unit

The aims of this study were: to follow the course of recovery of motor function following acute stroke, as assessed by the Physiotherapy Clinical Outcome Variables Scale (COVS), and; to investigate the ability of this instrument to predict length of hospital stay, discharge destination and future home facility. In this prospective longitudinal study, COVS was registered at admission and discharge from an acute stroke unit and at 3 months post-stroke onset. Sixty subjects were recruited consecutively from a sample of patients after first-ever acute stroke, and of these, 50 received follow-up assessment. Length of hospital stay, discharge destination and home facility 3 months post-stroke. The overall COVS scores increased significantly during the 3-month follow-up. The admission COVS score correlated negatively with length of stay. A cut-off at 50 points and 41 points could predict discharge destination and future home facility, respectively. COVS measures improvements and can predict length of hospital stay, discharge destination and future home facility. Thus, it could be used in early prediction for effective planning of the acute stroke unit services and efficient discharge planning.

Reliability of the Clinical Outcome Variables Scale When Administered Via Telephone to Assess Mobility in People With Spinal Cord Injury

Barker RN, Amsters DI, Kendall MD, Pershouse KJ, Haines TP. Reliability of the Clinical Outcome Variables Scale when administered via telephone to assess mobility in people with spinal cord injury. Objective To examine the equivalence reliability and test-retest reliability of the Clinical Outcome Variables Scale (COVS) when administered via telephone (TCOVS) to people with spinal cord injury (SCI). Design Equivalence (telephone administration vs in-person) and test-retest reliability study. Setting Assessments conducted in participants’ home environment. Participants Equivalence reliability was examined in a convenience sample of 37 people with a diagnosis of traumatic SCI who had been discharged from the Queensland Spinal Injuries Unit to the community. In a separate group of participants, test-retest reliability of COVS when administered via telephone was examined in 43 people with SCI who were randomly selected from the Queensland Spinal Cord Injuries Service records. Interventions Not applicable. Main Outcome Measures Reliability was assessed at the subscale and composite score level using intraclass correlation coefficients (ICC 2,1) and Bland-Altman limits of agreement. Results Reliability was good for TCOVS and COVS for the composite score (ICC=.98), mobility subscale (ICC=.97), and ambulation subscale (ICC=.99). Reliability was also good for TCOVS test and retest assessments for the composite score (ICC=1), mobility subscale (ICC=1), and ambulation subscale (ICC=1). For all comparisons, most data points were within the 95% limits of agreement and the width of limits of agreement were considered to be clinically acceptable. Conclusions The study findings confirm the equivalence and test-retest reliability of the TCOVS in an SCI population when administered by trained raters.

Recovery of Standing Balance and Health-Related Quality of Life After Mild or Moderately Severe Stroke

Garland SJ, Ivanova TD, Mochizuki G. Recovery of standing balance and health-related quality of life after mild or moderately severe stroke. Objective To examine the physiologic and functional recovery of standing balance and health-related quality of life (HRQOL) in people after mild and moderate stroke. Design Inception cohort study with evaluations at 1 month and 3 months poststroke. Setting Laboratory. Participants Twenty-nine volunteers who had sustained a stroke. Subjects were categorized into mild and moderate groups. Interventions Not applicable. Main Outcome Measures Functional balance was assessed (Clinical Outcome Variables Scale [COVS]) and physiologic measures (electromyography, postural sway) were taken when subjects stood quietly on a force platform and when they performed a rapid unilateral arm-raise perturbation. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was administered to evaluate HRQOL. Results Subjects in the mild group were approaching maximal scores on the COVS (87.7±4.1/91) at 3 months poststroke, yet had significant impairment in paretic muscle activation patterns when compared with healthy subjects. Subjects in the moderate group had increased paretic muscle activation over the 2 months, accompanied by significant increases of 10.7±5.9 points on the COVS. For both groups, there was significantly less postural sway on the paretic than the nonparetic leg and significant improvements in the SF-36 (physical component) over time. Conclusions Subjects recovering from a stroke showed a significant improvement in physical HRQOL and functional and physiologic balance, yet the physiologic balance recovery was not complete even in the mild group.

Recovery of standing balance and functional mobility after stroke

Garland SJ, Willems DA, Ivanova TD, Miller KJ. Recovery of standing balance and functional mobility after stroke. Arch Phys Med Rehabil 2003;84:1753–9. Objective To examine the extent to which recovery of functional balance and mobility is accompanied by change in a few specific physiologic measures of postural control. Design Longitudinal prospective study. Setting Laboratory setting in Ontario. Participants Twenty-seven volunteers (age, 64.2±13.7y) undergoing 4 weeks of rehabilitation after stroke participated. At initial testing, patients were 32.7±18.4 days poststroke and exhibited a moderate level of motor recovery (lower-extremity and postural control, stages 3–4 on the Chedoke-McMaster Stroke Assessment Impairment Inventory). Interventions Not applicable. Main outcome measures Three functional measures (Berg Balance Scale, Clinical Outcome Variables Scale, gait speed) were assessed. Three physiologic measures (electromyographic data of hamstrings and soleus muscles bilaterally, postural sway, arm acceleration) were taken while subjects stood quietly on a force platform and while they performed a rapid shoulder flexion movement of the nonparetic upper extremity. Results After 1 month of rehabilitation, there was an overall significant improvement in all outcome measures (functional, physiologic). However, 10 patients failed to show any improvement in the electromyographic activation of hamstrings muscle on the paretic side in response to the rapid arm movement. These patients compensated by increasing the anticipatory activation of the nonparetic hamstrings. Conclusion After stroke, patients showed improvement in both physiologic and functional measures of balance and mobility over a 1-month period. We have identified some patients who may be using compensatory strategies to increase function. The factors that may predict those patients who are likely to use compensatory strategies awaits further study.

Investigating the Suitability of the Clinical Outcome Variables Scale (COVS) as a Mobility Outcome Measure in Spinal Cord Injury Rehabilitation

Investigating the Suitability of the Clinical Outcome Variables Scale (COVS) as a Mobility Outcome Measure in Spinal Cord Injury Rehabilitation

Cognitive and functional assessments of stroke patients: An analysis of their relation

Objectives: To improve the assessment of stroke patients for the purpose of designing rehabilitation treatments and predicting rehabilitation outcomes. Specific objectives included the evaluation of the power of functional scales to properly assess both physical and cognitive disabilities, and the evaluation of the relations between functional, neurological, physical, and cognitive assessments. The hypothesis was that the relations between different assessment types (eg, functional, neurological, etc) can be assessed by the relations between the results of these assessments when administered to stroke patients. Design: Sixty-six stroke patients were administered a series of tests including functional assessments (Functional Independence Measure, Barthel Index, Rankin Functional Scale), neurological assessments (Canadian Neurological Scale, National Institute of Health Stroke Scale), physical assessments (Stages of Motor Recovery, Clinical Outcome Variables Scale), and cognitive assessments (Stroke Unit Mental Status Examination, Mini Mental State, Raven Matrices, Boston Naming Test). Results: Analysis of correlation coefficients revealed that the stronger relationships were observed between functional assessments and physical assessments, and between functional assessments and neurological assessments. Cognitive tests did not correlate highly with any of the functional tests used in this study. Three factors were extracted using factor analysis. They were interpreted as being a physical disability factor (50% of the variance), a cognitive disability factor (23% of the variance), and a dementia factor (12% of variance). Functional scales obtained higher loads on the physical disability factor only. Conclusions: Considering that cognitive functions are frequently affected in stroke patients, cognitive impairment needs to be more seriously considered when describing and/or predicting a patient's level of independence. In brain injured patients, such as stroke patients, we suggest that the total score provided by standardized functional scales should be interpreted with care. We believe that rehabilitation outcome could be better predicted if the results of functional assessment were coupled with in-depth cognitive assessment.

Aspects of cognitive status as predictors of mobility following geriatric rehabilitation.

This study aimed to determine the specific aspects of cognitive functioning which are related to geriatric rehabilitation treatment-outcome, and was based on a within-subject repeated measures design. In the setting of the inpatient Geriatric Rehabilitation Program (GRP) of the SCO Hospital in Ottawa, Canada 40 patients underwent six weeks of physiotherapy treatment for mobility training, on a twice daily schedule. Measurements were performed by the Clinical Outcome Variables Scale (COVS) and a mental status battery composed of five neuropsychological tests. Patients with a poorer mobility status at admission were significantly more depressed, more apraxic, less educated and had greater memory problems than their counterparts. The extent of treatment gains achieved by discharge was significantly related to a single aspect of cognition, namely procedural memory. Longer-term maintenance of treatment gains, however, was predicted by cognitive functioning more globally, including measures of praxis, declarative memory and reasoning. Together, the measures of cognition explained 52% of the variance in functional mobility outcome. In conclusion, patients with mild-to-moderate difficulties of cortically-based higher-order cognitive functions may still achieve significant gains in mobility function following geriatric rehabilitation. However, these patients may not be able to maintain their gains over time to the same extent as their cognitively healthier counterparts. Thus, from an empirical viewpoint, the decision to include or exclude cognitively impaired patients in GRPs varies with the definition of "treatment success" selected (i.e., short-term vs long-term gains). Alternatively, cognitively impaired patients may require more frequent follow-up rehabilitation services in order to maintain their gains.

Outcomes of enhanced physical and occupational therapy service in a nursing home setting

Objective: The purpose of this study was to determine if 1.0 Full-time Equivalent (FTE) physical therapy (PT) and 1.0 FTE occupational therapy (OT) per 50 beds resulted in differences in functional status for nursing home residents when compared to 1.0 FTE PT and 1.0 FTE OT per 200 beds. Design: Randomized control program evaluation, cost analysis. Setting: Nursing home in the province of Alberta, Canada. Patients: 115 residents assigned to 1 PT and 1 OT per 50 beds (enhanced group) versus 1 PT and 1 OT per 200 beds (control group) using stratified random allocation by severity of condition. Interventions: Both groups received ongoing treatment, follow-up, and restorative interventions, but enhanced group received more hours of service. Outcome Measures: Functional Independence Measure (FIM), Functional Assessment Measures (FAM), and Clinical Outcome Variables Scale (COVS) recorded at 6-month intervals over a 2-year period. Results: Mean score differences favored the enhanced group for the tests over the 2 years. Significance was observed on FIM Total at 6 and 12 months, FIM Self Care at 6 months, FIM Communication at 24 months, and FIM Psychosocial at 6, 12, 18, and 24 months; FAM Total at 6, 12, 18, and 24 months, FAM Self Care at 6 months, FAM Mobility at 12 months, FAM Communication at 6 and 24 months, FAM Psychosocial at 6, 12, 18, and 24 months, and FAM Cognition at 6 and 12 months; and COVS at 6, 12, 18, and 24 months. A cost analysis demonstrated that PT OT offered at the 1:50 ratio would result in a cost savings in terms of nursing staff dollars for 30 long-term—care beds of $16,973 over the 2 years of the study compared to the 1:200 ratio. This equates to an annual cost savings of $283 per bed. Conclusions: Increasing the amount of PT OT can have a positive effect on the functional status and cost of care of long-term care residents.