Enhanced Medical Rehabilitation in Older Adults

Study Overview
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Brief Summary
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The purpose of this study is to provide evidence that Enhanced Medical Rehabilitation is an effective treatment for older adults after disabling medical events.

Detailed Description
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The intervention involves physical and occupational therapy for patients who have been admitted to a skilled nursing facility for therapy following a disabling medical event. Participants in this study will be randomly assigned to receive either Enhanced or standard of care therapy, meaning they will either receive their PT (Physical Therapy)& OT(Occupational Therapy) from therapists who have been specially trained in the study intervention or from therapists with normal training. Participants will be assessed at baseline, 30, 60, and 90 days after baseline, and at the date of their discharge from the skilled nursing facility.

Official Title
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Enhanced Medical Rehabilitation in Older Adults

Conditions
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Disabling Medical Events, Disabled, Depression

Intervention / Treatment
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* Behavioral: Enhanced Medical Rehabilitation
* Behavioral: Standard of Care Rehabilitation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 65 and older Admitted to a skilled nursing facility for post-acute care from PT and OT for 2 weeks or more. Exclusion Criteria: Language, visual or hearing barriers to participation Medical illness preventing study participation or accurate data collection Moderate-severe dementia (demonstrated by chart diagnosis and/or short blessed score greater than 13) Progressive neurological condition such that recovery of function is not feasible Patient did not have the ability to walk prior to hospitalization (e.g. paraplegic) Schizophrenia or other chronic or current psychotic disorder.

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Standard of Care Rehabilitation<br> | Behavioral: Standard of Care Rehabilitation<br>* Daily PT/OT provided by therapists not trained in the treatment intervention.<br>|
| Experimental: Enhanced Medical Rehabilitation<br> | Behavioral: Enhanced Medical Rehabilitation<br>* Daily PT/OT provided by therapists trained in Enhanced Medical Rehabilitation. This training focuses on improved communication, patient engagement, and intensity.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Barthel Index Score | Barthel Index scores range from 0 to 100, with higher scores indicating greater levels of function. | Baseline and Discharge, an average of 24 days. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Gait Speed (Determined by 4 or 10 Meter Walk Test) | Meters walked per second. | Discharge, an average of 24 days after baseline. | 
| Distance Ambulated in 6-Minute Walk Test | Feet walked during 6 minute interval. | Discharge, an average of 24 days after baseline. | 
| Self-reported Barthel Index | Barthel Index scores range from 0 to 100, with higher scores indicating greater levels of function. Conducted as a self-report at timepoints where patient was not in an institutional setting. | 30, 60, and 90 Days Post Admission to the SNF | 
| Discharge Disposition | Number of participants discharged from skilled nursing facility to home | Discharge, an average of 24 days after baseline. | 
| Rehospitalizations | Assesses whether the participant was readmitted to the hospital. | Days 30, 60, and 90 post admission to a SNF as well as at Discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Physical Therapy, Occupational Therapy, Rehabilitation, Older adults, Depression, Physical Functioning