Improving Function in Older Veterans With Hospital-Associated Deconditioning
Condition: Frail Elderly; Homebound Persons
Study type: Interventional

Summary: 
      The investigators plan to test an innovative, home-based, short duration, high intensity
      exercise program designed for application in the immediate post-hospitalization period in
      older Veterans. Preliminary data suggest a more intensive approach to physical therapy in
      older adults after hospitalization is safe and maximizes mobility more than usual care. The
      Veterans participating in the high intensity exercise program will receive therapy utilizing
      higher resistance exercises. Outcomes from this group will be compared to data collected from
      the patients receiving standard, lower resistance therapies.
    

Detailed description: 
      Hospital associated deconditioning is a common and profound contributor to functional decline
      in older adults. Skeletal muscle weakness and atrophy are commonly observed in older adults
      with deconditioning after a hospitalizations, leading to chronic functional deficits. This is
      especially concerning for elderly Veterans, a population who tends to suffer from more
      chronic conditions and have decreased physical function than the general older adult
      population. Therefore, Veterans may be at even higher risk for developing disability in
      activities of daily living after hospitalization and be homebound. Home health physical
      therapy may be the ideal venue for addressing this functional decline as around 3 million
      older adults receive home health services following hospital discharge. These services,
      however, tend to be low intensity and do not appear to adequately address deficits in
      function or performance of home and community mobility. To address these concerns, the
      investigators have developed and tested an innovative, short-duration, home-based, high
      intensity exercise program designed for application immediately following hospitalization.
      This protocol will dose twelve therapy visits over the course of 30 days to determine whether
      visit frontloading has any effect on outcomes. The investigators are using a series of high
      resistance therapy exercises following acute hospitalization to determine if progressive high
      intensity therapy sustainability improves physical function more than standard home health
      physical therapy after an acute hospitalization in older Veterans. Outcomes will spotlight
      physical function, community mobility, Activities of Daily Living, quality of life, and
      cognition.
    

Intervention name(s): Progressive High Intensity Therapy (PHIT); Usual Care (UC)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants in the "Progressive High Intensity Therapy" (PHIT) group will receive high intensity physical therapy following discharge from acute hospitalization. The activities of training will include progressive resistance training, multi-planar motor control and gait exercises, and high intensity activities of daily living training. Like the Usual Care group, the PHIT participants will receive 12 intervention visits over 4 weeks (3 visits per week). Participants will also receive a standardized home exercise program.; Participants in the "Usual Care" group will receive standard 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 4 weeks (3 visits per week). Participants will also receive a standardized home exercise program.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Veterans; Progressive High Intensity Physical Therapy; Gait Speed; Acute Hospitalization; Hospital Associated Deconditioning