Physiotherapy Led Community Intervention for Older Adults Discharged From the Emergency Department
- Conditions
- Old Age; DebilityHealth Services for the Aged
- Interventions
- Other: Comprehensive Geriatric Assessment armOther: EDPLUS
- Registration Number
- NCT04983602
- Lead Sponsor
- University of Limerick
- Brief Summary
ED PLUS Emergency Department Discharge Physiotherapy Led Community Service is a pilot feasibility randomized controlled trial investigating the role of an integrated care intervention consisting of comprehensive geriatrics assessment in older adults in the emergency department and a physiotherapy-led community based intervention.
- Detailed Description
All patients who are aged 65 years and over will be screened using the Identification of Seniors at Risk (ISAR) Tool in the emergency department of a University Teaching Hospital. Those with a score of 2 or above in the ISAR and suitable for discharge home will be randomised. The first treatment arm will undergo geriatric medicine item directed Comprehensive Geriatric Assessment (CGA) from admission to emergency department (ED). The non-treatment arm will under usual patient care. The second treatment arm will undergo geriatric medicine team directed CGA from admission to ED and a physiotherapy led community based 6 week intervention in the patient's home. A dedicated multidisciplinary team of geriatric medicine trainee, occupational therapist, physiotherapist and medical social worker will carry out the assessment. For those randomised to the second treatment arm, a physiotherapist will assess and carry out a 6 week interventions that arise from that assessment and liaise with the patients General Practitioner (GP), medical social worker and other health care professionals. The overall aims of ED PLUS are assess the feasibility of the 6 week physiotherapy led intervention. Feasibility will be determined by the following outcomes:
i) Recruitment rate
ii) Adherence rate
iii) Acceptability of the programme
iv) Retention
v) Incidents
The secondary aims are to improve function, reduce anxiety and depression, improve quality of life and prevent unnecessary ED admission.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 29
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Comprehensive Geriatric assessment arm Comprehensive Geriatric Assessment arm The intervention will comprise initially of a detailed interdisciplinary assessment and intervention by one or more members of the dedicated geriatric team. The team (consisting of a geriatric specialist registrar, specialist geriatric nurse, senior pharmacist, senior physiotherapist, senior occupational therapist, and senior medical social worker) in both ED and AMAU will assess all participants in the intervention group and perform CGA. Potential participants will be approached regarding trial recruitment post ED triage thereby ensuring rapid assessment shortly after hospital arrival by the teams in both AMAU and in ED. EDPLUS arm EDPLUS The ED PLUS intervention will comprise initially of a detailed interdisciplinary assessment and intervention by one or more members of the dedicated geriatric team. The team in both ED and AMAU will assess all participants in the intervention group and perform CGA. Potential participants will be approached regarding trial recruitment post ED triage thereby ensuring rapid assessment shortly after hospital arrival by the teams in both AMAU and in ED. Additionally the participants in this arm will undergo a 6 week physiotherapy led intervention in the community involving 3 home visits and weekly telephone support. The intervention will involved assessment of the patients function in terms of strength, balance and mobility. Following assessment the intervention will be aimed at addressing deficits in the function of the participants, review of their medical management by a geriatrician trainee and focusing on self management of their own program.
- Primary Outcome Measures
Name Time Method Functional Decline 6 months post ED visit Barthel Index is global measure of functional status with a score from 0-20. A score of 0 is completely dependent, 20 is fully independent.
- Secondary Outcome Measures
Name Time Method Mortality 6 weeks post ED index visit or 6 months post ED index visit A record of the patient having died within 6 weeks or 6 months
Rate of Hospital readmission Baseline,6 weeks post ED visit and 6 months post ED visit A record of the patient requiring admission to the hospital within 6 weeks and/or 6 months
Patient Quality of Life Baseline, 6 weeks post ED visit and 6 months post ED visit Patient rated quality of life is determined by the Euro Quality of Life EQ5D. This scale is scored from 0 to 100 where 0 is the worst imaginable health state with 100 being the best imaginable.
Patient satisfaction Baseline, 6 weeks post ED visit and 6 months post ED visit Patient satisfaction is determined by the Patient Satisfaction Survey III Short Form (PSQ18). This is scored from 18 to 90, with 18 being the lowest level of satisfaction to 90 being the best score
Rate of ED representation Baseline, 6 weeks post ED visit and 6 months post ED visit A record of the patient coming back to the ED within 6 weeks and/or 6 months post ED index visit
Patient Experience Times 6 weeks Exact time of admission or discharge form the ED will be collected at 6 weeks post ED index visit
Number of visits to the family doctor or public health nurse 6 weeks and 6 months post index ED visit Determined by self reported visits to family doctor or public health nurse. This will be a telephone consultation at 6 week and 6 months post ED index visit where patients will be asked if they have visited a family doctor or public health nurse in the previous 6 weeks at the 6 week telephone call, or 6 months at the 6 month telephone call
Trial Locations
- Locations (1)
University Hospital Limerick
🇮🇪Limerick, Ireland