The Effectiveness of a Physiotherapy Led Community Based Intervention at Reducing Adverse Outcomes in Older Adults Discharged From the Emergency Department: A Pilot Feasibility Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 29
- 试验地点
- 1
- 主要终点
- Functional Decline
研究概览
简要总结
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.
详细描述
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
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
盲法说明
The outcomes assessor will be unaware if the participant was in usual care, comprehensive geriatric assessment arm or the ED PLUS arm
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •The inclusion criteria for participants include:
- •Adults aged ≥65 years with undifferentiated medical complaints presenting to an ED.
- •Medically stable as deemed by the treating physician
- •Display a score of ≥2 on the Identification of Seniors at Risk (ISAR) screening tool.
- •Be community dwelling
- •Be discharged from the ED within 72 hours of index visit.
排除标准
- •Individuals under the age of 65 years.
- •Have a score of less than 2 on the ISAR.
- •Older adults who present with acute myocardial infarction, stroke or non-medical problems e.g. surgical or psychiatric issues.
- •Older adults who are medically unstable will be excluded.
- •If neither the patient nor carer can communicate in English sufficiently to complete consent or baseline assessment, they will be excluded.
- •Older adults who are admitted to hospital from the ED will be excluded.
- •Older adults who have a confirmed COVID 19 diagnosis or those with symptoms highly suggestive of COVID 19 will be excluded.
研究组 & 干预措施
Usual care Control group
The usual care control group receives conventional care in the Emergency Department (ED) or Acute Medical Assessment Unit (AMAU)The comparison group will receive routine care as would be usual in the ED or AMAU. Currently there is no dedicated team to perform CGA in the ED and AMAU at UHL with ad hoc allied health assessment available only at the discretion of the referring ED doctor or medical team. This process will be continued during the study and will be documented. The participants in this group will under baseline data collection prior to randomisation and follow up.
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.
干预措施: Comprehensive Geriatric Assessment arm (Other)
EDPLUS arm
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.
干预措施: EDPLUS (Other)
结局指标
主要结局
Functional Decline
时间窗: 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.
Functional Decline
时间窗: 6 weeks 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.
次要结局
- Number of visits to the family doctor or public health nurse(6 weeks and 6 months post index ED visit)
- Mortality(6 weeks post ED index visit or 6 months post ED index visit)
- Rate of Hospital readmission(Baseline,6 weeks post ED visit and 6 months post ED visit)
- Patient Quality of Life(Baseline, 6 weeks post ED visit and 6 months post ED visit)
- Patient satisfaction(Baseline, 6 weeks post ED visit and 6 months post ED visit)
- Rate of ED representation(Baseline, 6 weeks post ED visit and 6 months post ED visit)
- Patient Experience Times(6 weeks)