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Older AdultsNCT02905370

Progressing Home Health Rehabilitation for Older Adults

A study testing Progressive Multi-Component (PMC) in people with Older Adults and Physical Deconditioning, run by University of Colorado, Denver at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This research study explores the effects of a progressive, multi-component intervention following a stay in the hospital or rehabilitation facility. The purpose of this research study is to compare a multi-component intervention (higher intensity exercise, nutritional supplementation, and greater emphasis on… Read more about this study

Who is it for?
Ages 65 to 100 years
Conditions the study is for
Older Adults, Physical Deconditioning
What is being tested?
Progressive Multi-Component (PMC)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
353 participants
Where
1 siteUnited States
Study dates
28 Sep 2016to 3 Jun 2022
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 65 to 100 years
  • All sexes
  • No healthy volunteers
  • Older adult

Who may be able to join

  • 65 years of age and older
  • Referred to home care physical therapy following acute medical deconditioning
  • Have at least 3 comorbid conditions including those listed below:
  • Chronic Obstructive Pulmonary Disease
  • Gastrointestinal Bleed
  • Urinary Tract Infection
Show all 28Show fewer
  • Pneumonia
  • Chronic ulcerative wounds
  • Diabetes
  • Hypertension
  • Depression/mental health
  • Irritable Bowel Syndrome
  • Hernia
  • Post-op pancreatic surgery
  • Osteoporosis/OA/RA/Gout
  • Heart Disease
  • Hypercholesterolemia
  • Peripheral Arterial Disease
  • Spinal Stenosis
  • Dehydration
  • Syncope
  • Atrial fibrillation
  • Hypo/Hyperthyroid
  • Renal Failure (no dialysis)
  • Post-op bowel surgery
  • Congestive Heart Failure
  • Be ambulatory without human assistance prior to hospitalization
  • Be English-speaking

Who cannot join

  • Acute lower extremity fracture with weight-bearing restriction
  • "Elective" joint replacement surgery
  • Lower extremity amputation
  • Acute cardiac surgery
  • Terminal illness
  • Active cancer treatment in which exercise is contraindicated
Show all 17Show fewer
  • Deep vein thrombosis/pulmonary embolus (DVT/PE)
  • Recent stroke (within 1 yr)
  • Score of <20 on SLUMS (as of 08.16.2018, revised to exclusion #14)
  • Inability to ambulate 10 feet without human assistance at time of hospital discharge
  • Gait Speed <0.3m/s or >1.0 m/s
  • Progressive neurodegenerative diagnosis (e.g. Parkinson's, MS, ALS)
  • Use of illegal substances
  • Clinical discretion of study physician to exclude patients who are determined to be unsafe and/or inappropriate to participate in high intensity rehabilitation as defined by the inclusion/exclusion criteria
  • Active involvement of Adult Protection Services
  • Current dialysis treatment
  • Prisoners or those on probation or other alternative sentencing

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Colorado Denver, Anschutz Medical Campus

    Aurora, Colorado, 80045

Other trials in United States

About this study

Official title: Progressing Home Health Rehabilitation Paradigms for Older Adults

This research study explores the effects of a progressive, multi-component intervention following a stay in the hospital or rehabilitation facility. The purpose of this research study is to compare a multi-component intervention (higher intensity exercise, nutritional supplementation, and greater emphasis on functionally enhanced care transitions) with usual care physical therapy.

Read the detailed description

Declines in physical function as a result of acute illness are strongly and independently associated with a number of adverse health events for older adults. Home Health (HH) physical therapy may be the ideal venue for addressing these declines in physical function because around 3 million older adults receive HH services following discharge from acute or post-acute facilities. However, as currently structured, HH care does not appear to adequately restore function, as evidenced by poor long-term outcomes and high rates of hospital readmission. Diminished physical function has been particularly implicated as a risk factor for re-hospitalization --older adults with lower levels of ambulatory activity are 6 times more likely to be re-hospitalized than those with greater ambulatory activity. A more intensive approach to HH physical therapy for older adults has great potential to maximize physical function and reduce hospital readmissions. Therefore, the investigators have developed a high intensity home-based, progressive, interdisciplinary, multi-component (PMC) intervention that directly addresses the functional deficits seen after hospitalization. This intervention will include intensive rehabilitation, a care transitions program, and daily protein supplementation. The investigators will conduct a two-arm, randomized clinical trial (RCT) of 200 participants admitted to HH from an acute or post-acute facility. Participants will receive either 1) an intensive, PMC intervention using resistance exercise and evidenced-based motor control training to improve physical function, along with nutritional supplementation and emphasis on functionally enhanced care transitions or 2) usual care (UC) physical therapy. The primary goal of this investigation is to determine if PMC intervention, initiated upon admission to HH, improves physical function, as measured by performance and self-report assessments, more than UC physical therapy. The investigators will also examine the effects on fatigue, balance confidence, and activities of daily living. In an exploratory analysis, the effects of the PMC intervention on re-hospitalization rates, nursing home placement, emergency room visits, and falls after discharge from the acute care hospital will also be examined. All outcomes will be examined at baseline, 30, 60 (primary endpoint), 90 and 180 days. If successful in improving patient function and decreasing re-hospitalization rates, PMC intervention holds potential for future health care cost savings.

Being tested
Progressive Multi-Component (PMC), Enhanced Usual Care (EUC)
Keywords
Home Health, Rehabilitation, High Intensity, Hospital Associated Deconditioning, Functional Mobility, Physical Function

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Progressive Multi-Component (PMC)Behavioural

    Participants in the "Progressive Multi-component" intervention group will receive 1) high intensity physical therapy, 2) protein supplement, and 3) emphasis on functionally enhanced transitions of care following discharge from post-acute setting. High intensity physical therapy will include progressive resistance training, multi-planar motor control and gait exercises, and high intensity activities of daily living training. Functionally enhanced transitions of care protocol includes a personal health record with 5 domains that are addressed in an interdisciplinary manner with the patient. Participants will receive 12 intervention visits over 60 days. Participants will also receive a home exercise program.

  • Enhanced Usual Care (EUC)Behavioural

    Participants in the "Enhanced Usual Care" group will receive standardized physical therapy following discharge from acute hospitalization. The activities of therapy will include basic strength training, single-planar motor control and gait exercises, and activities of daily living training. Participants will receive 12 intervention visits over 60 days. Participants will also receive a standardized home exercise program and standard nutritional education.

    Name of Participant Arm updated to "Enhanced Usual Care" from "Usual Care" effective 8/16/18 to distinguish from Passive Comparator "True Usual Care" group.

Study groups in NCT02905370
Study groupRoleWhat they receive
Progressive Multi-Component (PMC)ExperimentalHigh intensity strength training protocol, daily protein supplementation, functionally enhanced transitions of care
Receives: Behavioral: Progressive Multi-Component (PMC)
Enhanced Usual Care (EUC)Active comparatorLow intensity rehabilitation protocol, standard education for nutrition, standard transitions of care Name of Participant Arm updated to "Enhanced Usual Care" from "Usual Care" effective 8/16/18 to distinguish from Passive Comparator "True Usual Care" group.
Receives: Behavioral: Enhanced Usual Care (EUC)
True Usual Care (TUC)No interventionReal-world home health rehabilitation, real-world education for nutrition, real-world transitions of care, non-randomized observation Participants in the "True Usual Care" group will receive physical therapy following discharge from acute hospitalization. Activities and number of visits are not protocolized and are provided by real world home health care providers per physician orders. Participant Arm added effective 8/16/18.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Short Physical Performance Battery (SPPB)

    SPPB is a well-accepted global measure of lower extremity function which consists of walking speed, chair stands, and balance. It is a well-studied composite measure and a strong predictor of disability, institutionalization, and morbidity in older adults. SPPB will also be assessed at 30, 90, 180 days post-randomization.

    Measured: Change in SPPB from baseline to 60 days post randomization

Secondary outcomes (7)
  1. Modified Physical Performance Test (mPPT)

    mPPT assesses 7 tasks. Based on the time it takes to complete each task, a score from 0 (unable to complete) to 4 (performed quickly and easily) is given for each item. The maximal score is 28 and includes tasks that involve upper and lower extremity function. Test-retest reliability for the modified PPT score is 0.96. The instrument is sensitive to change and has been used in exercise trials with frail elders. mPPT will also be assessed at 30, 90, 180 days post-randomization.

    Measured: Change in mPPT from baseline to 60 days post randomization

  2. Fast walking speed (4MW)

    Will be assessed at the fastest, safe speed for each participant over 4 meters. Fastest walking assesses capacity for performance of certain activities (e.g. crossing a street before the light changes). Fast walking speed will also be assessed at 30, 90, 180 days post-randomization.

    Measured: Change in 4MW from baseline to 60 days post randomization

  3. ActivPAL

    Accelerometer-based physical activity examines volume and intensity of physical activity in which participants engage. Participants will wear a thigh-mounted activPAL physical activity monitoring device for up to 10 days to determine mean steps and activity counts per day (PAL Technologies, Glasgow, Scotland). Physical activity will also be defined as daily time spent in sitting, standing, and stepping. The activPAL has been found to be reliable (ICC≥0.99), valid (% Error =0.94% compared to video analysis; gold standard), and suitably sensitive to detect difference/change is similar populations. Physical activity will also be assessed at 30, 90, 180 days post-randomization.

    Measured: Change in physical activity from baseline to 60 days post randomization

  4. Falls Efficacy Scale-International

    Questionnaire assesses concern about falling during performance of activities of daily living. Participants rate 16 individual activities on a scale from 1 (not at all concerned) to 4 (very concerned). Falls Efficacy Scale-International will also be assessed at 30, 90, 180 days post-randomization.

    Measured: Change in Falls Efficacy Scale-International from baseline to 60 days post randomization

  5. Fatigue Severity Scale (FSS)

    A nine item questionnaire that quantifies the degree of fatigue and the impact of fatigue on activities of daily living in clinical populations. Participants score each of 9 components on a scale of 1 to 7. The aggregate score ranges from 9 (no impact) to 64 (profound impact of fatigue on activities of daily living). A total score of less than 36 suggests that a participant is not suffering from fatigue. The FSS is reliable (r=0.56-0.89), valid (α=0.97), and sensitive to change. FSS will also be assessed at 30, 90, 180 days post-randomization.

    Measured: Change in FSS from baseline to 60 days post randomization

  6. Patient Activation Measure (PAM)

    Identifies patient motivation levels regarding their healthcare. Reliably predicts future ER visits, hospital admissions, and medication/ therapy adherence. The survey classifies patient activation levels on a scale from 1 (low activation/motivation) to 4 (high activation/motivation). Patients who score higher on the PAM survey tend to be hospitalized less and adhere to medication and therapy schedules more.

    Measured: Change in PAM from baseline to 60 days post randomization

  7. Grip Strength

    Grip strength is a simple and reliable surrogate of overall muscle strength and a valid predictor of physical disability and mobility limitation. Grip strength will also be assessed at 30, 90, 180 days post-randomization.

    Measured: Change in Grip Strength from baseline to 60 days post randomization

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Sep 2016 (estimated)
  2. Study start28 Sep 2016
  3. Primary completion6 May 2022
  4. Study completion3 Jun 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
353 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02905370
Sponsor's protocol ID
15-2125
Other IDs
R01NR016209
Status last verified
Mar 2024
First submitted
14 Sep 2016
Last updated
7 Mar 2024
Results posted
No
Data monitoring committee
Yes
Individual data sharing
No

Publications

  • Cawood AL, Elia M, Stratton RJ. Systematic review and meta-analysis of the effects of high protein oral nutritional supplements. Ageing Res Rev. 2012 Apr;11(2):278-96. doi: 10.1016/j.arr.2011.12.008. Epub 2011 Dec 22.

    PubMed 22212388
  • Fisher SR, Kuo YF, Sharma G, Raji MA, Kumar A, Goodwin JS, Ostir GV, Ottenbacher KJ. Mobility after hospital discharge as a marker for 30-day readmission. J Gerontol A Biol Sci Med Sci. 2013 Jul;68(7):805-10. doi: 10.1093/gerona/gls252. Epub 2012 Dec 19.

    PubMed 23254776
  • Murkofsky RL, Alston K. The past, present, and future of skilled home health agency care. Clin Geriatr Med. 2009 Feb;25(1):1-17, v. doi: 10.1016/j.cger.2008.11.006.

    PubMed 19217489
  • Solomon DH, Wagner DR, Marenberg ME, Acampora D, Cooney LM Jr, Inouye SK. Predictors of formal home health care use in elderly patients after hospitalization. J Am Geriatr Soc. 1993 Sep;41(9):961-6. doi: 10.1111/j.1532-5415.1993.tb06762.x.

    PubMed 8409182
  • Timmer AJ, Unsworth CA, Taylor NF. Rehabilitation interventions with deconditioned older adults following an acute hospital admission: a systematic review. Clin Rehabil. 2014 Nov;28(11):1078-86. doi: 10.1177/0269215514530998. Epub 2014 May 20.

    PubMed 24844238
  • Garbin AJ, Falvey JR, Cumbler E, Derlein D, Currier D, Nordon-Craft A, Will R, Olivos M, Forster JE, Mangione KK, Stevens-Lapsley JE. Progressive Multicomponent Intervention for Older Adults in Home Health Settings Following Hospitalization: Randomized Clinical Trial. Phys Ther. 2024 Dec 6;104(12):pzae169. doi: 10.1093/ptj/pzae169.

    PubMed 39704300
  • Falvey JR, Mangione KK, Nordon-Craft A, Cumbler E, Burrows KL, Forster JE, Stevens-Lapsley JE. Progressive Multicomponent Intervention for Older Adults in Home Health Settings Following Acute Hospitalization: Randomized Clinical Trial Protocol. Phys Ther. 2019 Sep 1;99(9):1141-1149. doi: 10.1093/ptj/pzz069.

    PubMed 31004493

Questions about this trial

What is this clinical trial studying?

A study testing Progressive Multi-Component (PMC) in people with Older Adults and Physical Deconditioning, run by University of Colorado, Denver at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 28 inclusion and 17 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 7 Mar 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Short Physical Performance Battery (SPPB) (time frame: Change in SPPB from baseline to 60 days post randomization). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02905370, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Mar 2024.

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